Osteoarthritis of the knee joint (gonarthrosis): diagnosis and treatment

Up to 20% of all people over the age of 25 are at risk of developing deforming osteoarthritis of the knee. The knee joint works in axial compression mode, therefore its articular surfaces are subject to constant loads and are subject to degenerative changes in the hyaline cartilage.

Prevalence

The pathology of the articular cartilage of a degenerative-dystrophic nature with the involvement of bone tissue, joint bag, ligaments and muscles in the process is called arthrosis deformans. In terminology there are synonyms:

• osteoarthritis;
• osteoarthritis;
• degenerative arthritis;
• arthrosis;
• hypertrophic arthritis;

In terms of frequency, the knee injury occurs immediately after the hip joint, so a stable phrase has formed: "gonarthrosis of the knee joint". The dependence of the frequency of the disease on age was studied:

26 - 44 years old	5% of adults
45 - 59 years old	16, 70%
60 - 69 years old	12, 10%
70 years or older	eleven%

In all age groups, representatives of the fair sex quantitatively predominate. In them, knee arthrosis occurs 1, 2-1, 4 times more often than in men.

In the field of persistent disability, deforming arthrosis of the knee joint represents almost 30% of all causes of disability associated with joint pathology.

classification of gonarthrosis

For developmental reasons, the disease is divided into two large groups: primary and secondary. Primary spawns with no visible prerequisites. The secondary is preceded (or accompanied by) provoking factors:

1. biomechanical disorders: injuries, excessive loads, developmental anomalies (dysplasia), skeletal pathology (scoliosis, flat feet), obesity;
2. inflammatory processes: aseptic or infectious arthritis, frequent hemarthrosis in hemophilia;
3. metabolic diseases: gout, hemochromatosis, Paget's disease;
4. disorders of the endocrine glands: acromegaly, diabetes mellitus, disorders of the parathyroid glands;
5. violations of adequate blood supply: varicose veins and postthrombophlebitic syndrome, endarteritis obliterans, atherosclerosis of the vessels of the lower limb;

In medical practice, classification according to the severity of pathological changes is most useful. The assessment is done according to X-ray studies. The most popular clinical and radiological classification.

I stage

The picture shows a slight narrowing of the interarticular space (a comparison is made with a healthy joint), the beginning of sclerosis of the pericartilaginous bone tissue. Clinically - pain occurs while walking or immediately after, with prolonged standing. More pronounced when climbing stairs. Pass at rest. First-degree gonarthrosis does not greatly affect joint function.

II stage

The joint space is 2-3 times narrower than normal. Sclerosis is more pronounced, osteophytes are found (sharp growths of bone tissue along the edges of the joint space and condyles). The pain is moderate, there are signs of muscle atrophy, lameness. The deformation of the knee in the frontal axis is visible. Second-degree gonarthrosis leads to a notable limitation of joint mobility.

III stage

Sclerosis of cartilaginous elements, deformation of joint surfaces. There are areas of subchondral necrosis, local osteoporosis. Cysts in adjacent bone tissue. The joint space is critically narrow, sometimes not defined. Osteophytes of considerable size. Atrophy of the muscles of the thigh and lower leg, the joint is unstable, there is a pronounced deformity. Movement in the knee is sometimes impossible, a contracture is formed. When moving - severe pain, lameness.

This classification approach is convenient in that it allows evaluating clinical manifestations in relation to organic changes. It gives the opportunity to choose a more effective treatment based on a comprehensive assessment of the state of the joint.

development mechanism

The pathogenesis of any arthrosis goes through three stages:

1. Damage to cartilage microstructures. Under the influence of any of the harmful factors, high molecular weight compounds lose their strength and are enriched with water molecules. The ability of low molecular weight collagens to assemble into macromolecules is impaired. This leads to a decrease in the strength and durability of the hyaline cartilage. Chondroprotectors counteract such phenomena.
2. If the provoking factor is not eliminated, the weakening of cartilage components (glycosaminoglycans, proteoglycans) continues. This leads to activation of recovery processes. Its energy reserve is not particularly large, so this stage quickly passes to the next.
3. Disruption of compensatory mechanisms leads to the progressive destruction of joint cartilage, death of its cells - chondrocytes. Cracks in the cartilage extend down to the underlying bone. The degree of detachment of cartilaginous components increases, their defibrillation occurs, which leads to thinning of the hyaline membrane.

On the part of the bone, with deforming arthrosis of the knee joint, thickening (sclerosis) occurs, cysts and areas with uneven bone density appear. Thus, deformation of the joint surfaces, instability of the joint develops.

Diagnosis

The diagnosis is based on a set of data obtained as a result of a survey (anamnesis), medical examination and instrumental research methods. The latter include radiographic examinations (CT, MRI), radioisotopes (scintigraphy), arthroscopy.

objective exam

It includes clarification of the patient's life history, circumstances that preceded the development of gonarthrosis of the knee joint, collection of complaints and examination. In the process, the presence of triggering factors and the degree of their influence on the development of the disease are clarified.

At this stage, it is important to find out the condition of the second knee. If you miss bilateral gonarthrosis and focus only on the knee you are most concerned about, you could make a gross diagnostic error.

For this, functional tests must be performed on two members at the same time. The pain of active and passive movements, sensitivity to palpation, crackling (crushing) during extension and flexion draws attention. Chronic inflammatory processes lead to the appearance of Becker's cyst - a protrusion of the joint bag into the popliteal fossa, which can also be detected by palpation.

Instrumental Methods

The first is radiography. An image of the knee in two projections allows a preliminary assessment of the condition of the joint and determines the stage of the disease. The disadvantage of the method is that radiological signs occur later than the symptoms and morphological changes that accompany arthrosis of the knee joint.

In such cases, MRI (MRI) helps. It is possible to determine the initial stages of degenerative changes in cartilaginous and bone structures, it is possible to assess the state of intra-articular ligaments, menisci. Scintigraphy for gonarthrosis of the knee joint provides data on the functional status.

Direct examination of the joint cavity is possible with arthroscopy.

For the unification of diagnostic data, the American College of Rheumatology proposed the following criteria:

• Age above 50 years.
• Stiffness in the joint in the morning, which persists for at least half an hour.
• Cracking, determined by movement (active and passive).

If these symptoms are accompanied by osteophytes found on radiography and pain, it is highly likely that gonarthrosis of the knee joint has occurred.

The initial stages of the disease may not be pronounced, therefore, it is necessary to carry out differential diagnoses with other joint pathologies, in which pathogenic drugs for osteoarthritis (chondroprotectors) will be ineffective.

All possible measures should be taken not to confuse gonarthrosis with the following conditions:

Rheumatoid arthritis	Onset at an early age, morning stiffness for more than 30 minutes, pain worse at rest and less so on movement, rheumatoid nodules on the skin, concomitant damage to internal organs, symptoms of intoxication (fever, sweating), C-reactive protein on blood tests blood.
crystal arthritis	The pain is sharp, at night or in the morning; the skin over the diseased joint is edematous, red, hot; crystals in a microscopic examination of synovial fluid, increased uric acid in the blood (with gout).
spondyloarthropathies	Arthritis of other unrelated joints (intercostal joint, lumbar); inflammatory processes in the tendons; damage to the cornea, skin, mucous membranes.

In the International Classification of Diseases of the Tenth Revision (ICD 10), all these diseases are assigned the "M" index, but a different numerical code.

These are fundamentally different pathological processes that require a professional approach to diagnosis and qualified treatment.

therapeutic measures

If there is a disease, then there must be ways to cure arthrosis of the knee joint. And they exist. Help can be provided in many ways.

In the first place are the achievements of traditional medicine, based on a deep study of the causes and mechanisms of the disease. Medical and surgical methods are used here. Competent treatment requires consistent and complex use of drugs, physiotherapy methods and rehabilitation measures.

The second way is treatment with folk remedies. The effectiveness of these methods, to put it mildly, is questionable. But they are used, because it is possible to reduce the manifestations of the disease at home. Folk remedies can only be used as an addition to drug treatment or as part of complex therapy, it is imperative to obtain the consent of the attending physician!

medicinal aid

This type of treatment includes the use of various medications. For medicinal purposes, drugs from different groups are used:

1. nonsteroidal anti-inflammatory drugs, analgesics, opiates;
2. symptomatic slow-acting drugs (chondroprotectors);
3. glucocorticoid hormones;

NSAIDs, rapid pain relievers, opiates

Medicines from this group are designed to eliminate pain. Pain syndrome practically spoils the lives of patients with arthrosis, its removal significantly improves the quality of human life. NSAIDs, anilids, non-narcotic and narcotic analgesics are capable of this.

A common drawback is side effects. These drugs negatively affect the kidneys, the protective mechanisms of the gastrointestinal tract. An alternative that can reduce harmful manifestations is injections. Intramuscular administration does less damage to the stomach and accelerates the effect.

Due to side effects, drugs from this group are prescribed during exacerbations, careful selection of the dose is required.

The main advantage of NSAIDs is the various forms of local treatment (ointments, gels). Allows you to control the manifestations of the disease at home.

Central action analgesics are prescribed for a short period, with ineffectiveness in the other two groups. The most popular opioid is prescribed during an exacerbation, most often with bilateral gonarthrosis. These drugs are addictive. You cannot take them alone!

Slow-acting symptomatic drugs

The action of these substances is twofold: they have the ability to reduce pain (like NSAIDs) and contribute to the restoration of hyaline cartilage. Often they are called chondroprotectors.

The effect develops over several weeks (2-8) and persists after cancellation for 2-3 months.

In addition to chondroitin sulfate and glycosaminoglycans, this group includes preparations based on hyaluronic acid, compounds derived from avocado and soy.

The most studied and popular chondroprotectors (chondroitin sulfate and glycosaminoglycans) are ready-made components of articular cartilage. Well absorbed into the blood, it forms high concentrations in the joint cavity. To accelerate the effect, injections can be made directly into the joint.

It has been proved that chondroitin sulfate, administered in two-year courses at a daily dose of 800 mg, has a stabilizing effect on the joint space in gonarthrosis of the 2nd degree knee joint.

Avocado/soy compounds have anti-inflammatory effects. Due to the inhibition of collagenase (a decomposition enzyme), they significantly slow down the destruction of cartilage, increase the synthesis of "own" collagen. They are also very well tolerated.

Hyaluronic acid derivatives are used in the form of intra-articular injections. These funds, like chondroprotectors, improve the functional state of the knee joint.

The mechanism of action of various slowly symptomatically acting drugs is somewhat different, therefore their combined use is recommended. A high level of safety allows you to take chondroprotectors for a long time without tangible harm to the body.

Glucocorticosteroids

The main action is anti-inflammatory. These funds are prescribed when NSAIDs are ineffective. Pill forms also damage the stomach lining. There are forms for intra-articular injections.

They have numerous side reactions, so you should not abuse hormonal drugs to deform arthrosis of the knee joint.

Group's name	Benefits	imperfections
NSAIDs, analgesics, opiates	Fast effect, many forms for topical application.	Side effects, unstable effect, dangerous for age-related patients, dependence occurs.
Chondroprotectors	They act pathogenically, have a lasting effect, are not toxic, there are forms for external and intra-articular use.	Slow development of the effect.
hormones	Fast effect where NSAIDs are not enough; forms for intra-articular administration.	Side effects, unstable effect, long-term use is impossible.

ethnoscience

At home, you can reduce the manifestations of the disease with folk remedies. There are many recipes, but there are few, but:

• no clinical studies have been conducted;
• it is impossible to accurately dose the medicinal substance;
• indications are not clearly defined;
• individual tolerance of folk remedies is not taken into account;

The advantages include a wide therapeutic range, a large selection for external use. Home compresses and tinctures, ointments are popular.

The effectiveness of home treatment can be proved by the fact that biologically active substances (gum, bile, infusions of medicinal plants) are used for its preparation.

Also, competent treatment with folk remedies begins with following a diet, losing weight. This method alone, aimed at reducing the load on the joint, can reverse knee joint osteoarthritis of the 1st degree (the condition is young, sufficient compensatory skills). Healthy eating alone stimulates the body's regenerative capabilities. The diet includes: a slight feeling of hunger, vegetables, freshly squeezed juices. It is advisable to add low-fat jams, jellies to the diet.

External means are very diverse. They mainly have an irritating and warming effect. The most studied components are bile, dimethyl sulfoxide and bischophite. Bile should be used clinically and not independently extracted from an animal's cadaver. Dimethyl sulfoxide is an analogue of a chemical warfare agent, mustard gas. Bischofite is a petroleum derivative. This is the original difference.

All three drugs have an anti-inflammatory effect, however, at home they should be used only after consulting a doctor. These substances also have contraindications and application features.

We must not forget about the placebo effect in the treatment of folk remedies.

The last thing I want to convey is that a person has health. You should not completely rely on the seeming simplicity and low cost of folk remedies. If you have already decided to try them, increase your attention to the sore joint. The progression of the disease against the background of treatment with folk remedies is a reason to reconsider the approach to therapy.

If grade 2 or higher osteoarthritis of the knee joint is diagnosed, it is better not to mess with traditional medicine. Or postpone it for a period of remission. Unsatisfactory treatment is an indication for complex surgical intervention.